Occult Head Injury is Common in Children with Concern for Physical Abuse

Overview

Journal Pediatr Radiol

Specialty Pediatrics

Date 2018 Apr 15

PMID 29654352

Citations 7

Authors

Mitchell Boehnke

David Mirsky

Nicholas Stence

Rachel M Stanley

Daniel M Lindberg

Affiliations

Soon will be listed here.

Abstract

Background: Studies evaluating small patient cohorts have found a high, but variable, rate of occult head injury in children <2 years old with concern for physical abuse. The American College of Radiology (ACR) recommends clinicians have a low threshold to obtain neuroimaging in these patients.

Objectives: Our aim was to determine the prevalence of occult head injury in a large patient cohort with suspected physical abuse using similar selection criteria from previous studies. Additionally, we evaluated proposed risk factors for associations with occult head injury.

Materials And Methods: This was a retrospective, secondary analysis of data collected by an observational study of 20 U.S. child abuse teams that evaluated children who underwent subspecialty evaluation for concern of abuse. We evaluated children <2 years old and excluded those with abnormal mental status, bulging fontanelle, seizure, respiratory arrest, underlying neurological condition, focal neurological deficit or scalp injury.

Results: One thousand one hundred forty-three subjects met inclusion criteria and 62.5% (714) underwent neuroimaging with either head computed tomography or magnetic resonance imaging. We found an occult head injury prevalence of 19.7% (141). Subjects with emesis (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-6.8), macrocephaly (OR 8.5, 95% CI 3.7-20.2), and loss of consciousness (OR 5.1, 95% CI 1.2-22.9) had higher odds of occult head injury.

Conclusion: Our results show a high prevalence of occult head injury in patients <2 years old with suspected physical abuse. Our data support the ACR recommendation that clinicians should have a low threshold to perform neuroimaging in patients <2 years of age.

Citing Articles

Identifying Risk Factors of Children Who Suffered Physical Abuse: A Systematic Review.

Flaherty A, Ghandour S, Mirochnik K, Lucaciu A, Nassour N, Kwon J J Am Acad Orthop Surg Glob Res Rev. 2025; 9(1.

PMID: 39823216 PMC: 11741222. DOI: 10.5435/JAAOSGlobal-D-24-00163.

Effect of Routine Child Physical Abuse Screening Tool on Emergency Department Efficiency.

Shahi N, Meier M, Reppucci M, Pickett K, Phillips R, McLean M Pediatr Emerg Care. 2024; 40(7):509-514.

PMID: 38713842 PMC: 11216854. DOI: 10.1097/PEC.0000000000003205.

Development, contributions, and future directions of a multicenter child abuse research network.

Henry M, Lindberg D, Campbell K, Wood J Curr Probl Pediatr Adolesc Health Care. 2024; 54(3):101573.

PMID: 38522960 PMC: 11221416. DOI: 10.1016/j.cppeds.2024.101573.

Imaging of Abusive Head Trauma : A Radiologists' Perspective.

Cheon J, Kim J J Korean Neurosurg Soc. 2022; 65(3):397-407.

PMID: 35483021 PMC: 9082130. DOI: 10.3340/jkns.2021.0297.

Practice Variation in Use of Neuroimaging Among Infants With Concern for Abuse Treated in Children's Hospitals.

Henry M, Schilling S, Shults J, Feudtner C, Katcoff H, Egbe T JAMA Netw Open. 2022; 5(4):e225005.

PMID: 35442455 PMC: 9021910. DOI: 10.1001/jamanetworkopen.2022.5005.

References

Mathews J, Forsythe A, Brady Z, Butler M, Goergen S, Byrnes G . Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013; 346:f2360. PMC: 3660619. DOI: 10.1136/bmj.f2360. View

Pierce M, Kaczor K, Aldridge S, OFlynn J, Lorenz D . Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics. 2009; 125(1):67-74. DOI: 10.1542/peds.2008-3632. View

Brenner D, Hall E . Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007; 357(22):2277-84. DOI: 10.1056/NEJMra072149. View

Wilson P, Chua M, Care M, Greiner M, Keeshin B, Bennett B . Utility of head computed tomography in children with a single extremity fracture. J Pediatr. 2014; 164(6):1274-9. DOI: 10.1016/j.jpeds.2013.12.041. View

Slovis T, Strouse P, Strauss K . Radiation Exposure in Imaging of Suspected Child Abuse: Benefits versus Risks. J Pediatr. 2015; 167(5):963-8. DOI: 10.1016/j.jpeds.2015.07.064. View

Palusci V, Covington T . Child maltreatment deaths in the U.S. National Child Death Review Case Reporting System. Child Abuse Negl. 2013; 38(1):25-36. DOI: 10.1016/j.chiabu.2013.08.014. View

Stanley R, Nigrovic L . Research priorities for a multi-center child abuse network: Lessons learned from pediatric emergency medicine networks. Child Abuse Negl. 2017; 70:414-416. DOI: 10.1016/j.chiabu.2017.03.020. View

Schonfeld D, Bressan S, Da Dalt L, Henien M, Winnett J, Nigrovic L . Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice. Arch Dis Child. 2014; 99(5):427-31. DOI: 10.1136/archdischild-2013-305004. View

Trokel M, Waddimba A, Wadimmba A, Griffith J, Sege R . Variation in the diagnosis of child abuse in severely injured infants. Pediatrics. 2006; 117(3):722-8. DOI: 10.1542/peds.2004-2731. View

10.

Lindberg D, Blood E, Campbell K, Laskey A, Berger R . Predictors of screening and injury in contacts of physically abused children. J Pediatr. 2013; 163(3):730-5.e1-3. DOI: 10.1016/j.jpeds.2013.02.051. View

11.

Christian C . The evaluation of suspected child physical abuse. Pediatrics. 2015; 135(5):e1337-54. DOI: 10.1542/peds.2015-0356. View

12.

Duhaime A, Christian C, RORKE L, Zimmerman R . Nonaccidental head injury in infants--the "shaken-baby syndrome". N Engl J Med. 1998; 338(25):1822-9. DOI: 10.1056/NEJM199806183382507. View

13.

Laskey A, Holsti M, Runyan D, Socolar R . Occult head trauma in young suspected victims of physical abuse. J Pediatr. 2004; 144(6):719-22. DOI: 10.1016/j.jpeds.2004.02.023. View

14.

Lindberg D, Shapiro R, Laskey A, Pallin D, Blood E, Berger R . Prevalence of abusive injuries in siblings and household contacts of physically abused children. Pediatrics. 2012; 130(2):193-201. DOI: 10.1542/peds.2012-0085. View

15.

Rubin D, Christian C, Bilaniuk L, Zazyczny K, Durbin D . Occult head injury in high-risk abused children. Pediatrics. 2003; 111(6 Pt 1):1382-6. DOI: 10.1542/peds.111.6.1382. View

16.

Berger R, Fromkin J, Herman B, Pierce M, Saladino R, Flom L . Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma. Pediatrics. 2016; 138(1). PMC: 4925074. DOI: 10.1542/peds.2015-3756. View

17.

Wootton-Gorges S, Soares B, Alazraki A, Anupindi S, Blount J, Booth T . ACR Appropriateness Criteria Suspected Physical Abuse-Child. J Am Coll Radiol. 2017; 14(5S):S338-S349. DOI: 10.1016/j.jacr.2017.01.036. View

18.

Starling S, Patel S, Burke B, Sirotnak A, Stronks S, Rosquist P . Analysis of perpetrator admissions to inflicted traumatic brain injury in children. Arch Pediatr Adolesc Med. 2004; 158(5):454-8. DOI: 10.1001/archpedi.158.5.454. View

19.

Kuppermann N, Holmes J, Dayan P, Hoyle Jr J, Atabaki S, Holubkov R . Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009; 374(9696):1160-70. DOI: 10.1016/S0140-6736(09)61558-0. View

20.

Magana J, Kuppermann N . The PECARN TBI Rules Do Not Apply to Abusive Head Trauma. Acad Emerg Med. 2017; 24(3):382-384. DOI: 10.1111/acem.13155. View